THEME

Sexual and Reproductive Health Group

We contribute to the improvement of sexual and reproductive health (SRH) through linking scientific research, advanced education, policy support and capacity-strengthening. We focus on the broader perspective of promoting sexual and reproductive health and rights through addressing one overarching research question: “How can we improve SRH focusing on disease prevention and health promotion  in a globalized world?”

We believe that people in all parts of the world should be able to make informed choices about their SRH respecting sexual and reproductive rights in enabling environments, with equal access, built on scientific evidence. Our work is focused around several critical intersections between four key populations and SRH topics.

We use quantitative, qualitative and mixed method inter-disciplinary approaches (e.g. epidemiology, sociology, anthropology, psychology, demography) that explain risk and vulnerability as evidence base for improving SRH outcomes.

We contribute actively to teaching at ITM and externally, including on the following:

      • Masters in Public Health
        • HIV & STI Response 3-week course
        • Sexual and Reproductive Health 3-week course
      • Short Course in Qualitative and Mixed Methods research in International Health
      • Postgraduate Certificate in Tropical Medicine and International Health
      • Tropical Medicine for Bachelors in Nursing and Midwifery (English and French)

Follow us on twitter @SRHGroup_ITM.

The Sexual and Reproductive Health Group has been created by “merging” two research units (HIV and Sexual Health and Maternal and Reproductive Health).

Current Projects

PROMISE

Pre-exposure prophylaxis (PrEP) has the potential to be a game-changer in controlling the HIV epidemic. Belgium adopted PrEP to strengthen the national HIV control strategy in 2017. However, important questions on whether and how the demonstrated clinical efficacy of PrEP will translate into population-level effectiveness are still unanswered. The overall objective of this project is to learn how PrEP roll-out can be optimized to result in maximum impact on HIV and sexual health. To reach the objective, the project is composed of 4 thematic Work Packages (WP). Uptake and use of PrEP in large-scale programs will depend on how individuals and communities engage this new prevention measure: men having sex with men (MSM) (WP 1)and people with migrand background (WP2). It also remains unclear which delivery models are most suited to provide and support PrEP use as part of combination prevention: PrEP user’s needs (WP3) and health care provider’s options (WP4). PROMISE is funded by FWO (Strategic Basic Research, SBO). It has a duration of four years, starting from 2019. The consortium consists of the team at ITM (coordinator) and the team of Dr. Edwin Wouters at the University of Antwerp.  

Contact person: Bea Vuylsteke
Project website: coming shortly, please stay tuned
Also visit the website of the Be Prep-ared project.

The ALERT intervention research project

Intrapartum care needs more attention: every day more than 7,000 women and their offspring could be saved if known evidence-based intervention were consistently implemented during the few hours surrounding birth. Hospitals care for about 40-50% of all births in Sub-Saharan Africa including complicated births. ALERT (Action Leveraging Evidence to reduce perinatal Mortality and morbidity in Sub-Saharan Africa) is a 5-year hospital maternity-based quality improvement and implementation science project in Benin, Malawi, Tanzania and Uganda. The project is coordinated at Karolinska Institutet, by the project coordinator Dr Claudia Hanson, and funded by the European Commission’s Horizon 2020. The aim of the project is to develop and evaluate a multifaceted intervention to strengthen the implementation of evidence-based interventions and responsive care and reduce in-facility perinatal mortality and morbidity through a multidisciplinary approach. Our team is a multi-disciplinary team of clinicians (obstetrics and midwifery), public health physicians, social scientists, health systems specialists, medical anthropologists, economists, and management scientists from leading universities and research institutions. The principal investigator (and ITM contact person) for this project at ITM is Dr. Lenka Benova, who works closely with Prof. Bruno Marchal and Prof. Wim Van Damme to deliver the realist and economic evaluation components of this project.

Contact person: Lenka Benova
Project website: ALERT project on Karolinska Institutet website

Belgian Development Cooperation (DGD) and Technical Cooperation (ENABEL) projects

  1. In Guinea the SRH Group provides scientific support to develop and implement jointly with the Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) Maferinyah,  e-learning modules on Management of Sexual and Reproductive Health programmes/services (eSSR course), Primary Health Care (eSSP course) and Methods Research (eMR course). 
  2. In Cambodia the SRH Group has a long term collaboration with the National Center of HIV/AIDS, Dermatology and STD (NCHADS) and contributes to strengthening the capacity in conducting operational research (OR) (e.g. PMTCT cascade analysis; Follow-up of Congenital Syphilis) and implementing integrated and evidence-based HIV strategies.
  3. In Benin the SRH Group collaborates with le Centre de Recherche en Reproduction Humaine et Démographie (CERRHUD) to explore determinants of utilization of SRH services along the Continuum of care.
  4. In Burkina Faso the SRH Group collaborates with Centre Muraz to conduct operations research setting up and evaluating cervical cancer screening strategies for female sex workers. 

Contact person: Thérèse Delvaux 

Dynamics between sexual risk behaviour, social context and the use of PrEP among MSM

Pre-Exposure Prophylaxis (PrEP) - the preventive use of antiretroviral medication - is a novel and highly efficacious tool, which could have an important impact on the HIV epidemic among men who have sex with men (MSM). It has recently been made available in Belgium and other countries, and will soon be implemented in many countries throughout the world. But to maximise the impact of PrEP, we need better insights to optimise the roll-out of this novel tool. This project, funded by FWO to Dr Thijs Reyniers (as a junior postdoctoral fellow) and ANRS, aims to gain knowledge on PrEP use and sexual behaviour to provide better insights into PrEP users’ needs; to explore how PrEP use may be influenced by social context; and to explore barriers and facilitators for providing PrEP, using PrEP and reaching MSM in 4 West-African countries (Burkina Faso, Côte d’Ivoire, Mali and Togo). In Belgium, we will use quantitative data (medical records and surveys) collected among PrEP users who have come forward in Antwerp since June 2017 and additionally conduct in-depth interviews to gain insights into their needs towards PrEP care. In Burkina Faso, Côte d’Ivoire, Mali and Togo a local research team is set up to conduct interviews with PrEP users and providers, and focus group discussions with MSM. In both data collections, we will particularly focus on how social context may shape the use of PrEP. The results of this project will enable a better understanding of how to optimise the roll-out of PrEP, while taking into account the social context in which it is implemented.

Contact person: Thijs Reyniers

Examining barriers to providing good quality postnatal care

Many women die during pregnancy and childbirth around the world and this problem is most urgent in low-resource contexts such as sub-Saharan Africa. Close monitoring of women and babies during the first hours and days after childbirth (the postnatal period) can save many lives. More than half of births in low-resource countries now occur in health facilities, which should make it easier to provide postnatal monitoring and treatment if necessary. However, many women are not receiving even basic postnatal care, such as staying long enough in the facility, or being checked before discharge. This project is funded by FWO under the Senior Postdoctoral Fellowship Scheme to Dr. Lenka Benova. Within it, she will explore the barriers and enablers to providing postnatal care monitoring to women before and after discharge from health facilities in Tanzania and Guinea. Quantitative data from patient records and qualitative data from interviews with clinicians and women will be used. The findings will better enable countries and health facilities to implement new WHO postnatal care recommendations (expected in 2020).

Contact person: Lenka Benova

HIV-SAM

People of sub-Saharan African descent are an important priority population for HIV prevention in Europe. In Belgium, they are the second largest group among newly reported HIV infections (28% in 2018), while constituting a small population minority (i.e. 1.6% of the Belgian population).  Several factors account for this phenomenon, e.g. high HIV prevalence in small sexual networks, migration-related hardship and socio-economic precarity, HIV-related stigma and low HIV prevention demand. To account for this reality, HIV prevention and sexual health promotion for this population at higher risk of HIV acquisition must be tailored to their needs, requiring an in-depth understanding of epidemiological and social factors driving HV transmission dynamics.  Against this background, the HIV-SAM project develops and implements HIV prevention and sexual health promotion for sub-Saharan African migrants living in Flanders for more than two decades. The project is commissioned by the Flemish Ministry of Welfare, Public Health, Family and Poverty Reduction. The project adopts an evidence-based and participatory approach to develop and implement HIV prevention and sexual health promotion. Implementation is strongly linked to research to inform evidence-based interventions in line with the HIV care continuum, i.e. primary HIV prevention, HIV testing and linkage to care, and supporting people living with HIV (PLHIV) in treatment adherence and achieving a good quality of life. The participatory approach allows for creating ownership of HIV prevention in the affected communities. The project closely collaborates  with HIV prevention networks of African communities including socio-cultural associations, churches, patient associations, and committed individual volunteers.  Important activities are the promotion and implementation of de-medicalised HIV testing activities to reach African migrants and newcomers with a migrant background with undiagnosed HIV.  Recent research activities include a representative HIV prevalence study using community-based-participatory research (Loos et al., 2017) and a qualitative investigation of HIV-stigma, its manifestations and outcomes in the community and among HIV positive sub-Saharan African migrants currently under way. As migration is an increasing global public health priority with considerable health impact, we are currently widening the scope of our research interest in migration and health:  we are collaborating with CeMIS by organizing an annual symposium on migration and health, and developing research proposals on broader health promotion topics relevant for people with a migrant background.  

Contact persons: Christiana Nöstlinger, Lazare Manirankunda
Website: http://www.hivsam.be/

Projects examining SRH among adolescents

Adolescents and young people (10-24 years) are an important key population in global efforts to eliminate HIV, but also more widely for supporting them in achieving good SRH. AIDS is still the leading cause of death among young people in Africa, and the second leading cause globally, and in many parts of the world adolescents have worse treatment outcomes compared to children and adults. In addressing these challenges, the groups’ research focus is on drivers of HIV transmission among adolescents and young people, and on the systematic development and evaluation of interventions to improve their SRH. A current  PhD project conducted by Okikiolu Badejo in Nigeria aims at unpacking what constitutes “youth-friendly” services, and at a better understanding of what may constitute a minimum package of care considering substantial differences among adolescents and young adults in terms of their HIV service needs. Using mixed methods research, the study will characterize patterns of care engagement and virologic suppression among adolescent and young people living with HIV, as well factors driving the observed patterns across the spectrum of adolescents and young people living with HIV.
In Zimbabwe, in collaboration with CeSHHAR, we are implementing and evaluating a project on second chance education among highly-vulnerable adolescent girls.

Contact persons: Christiana Nöstlinger, Marie Laga

Co-MSM-PrEP

CohMSM-PrEP is a Pre-Exposure Prophylaxis (PrEP) demonstration project in 4 West African countries: Mali, Burkina Faso, Côte d’Ivoire and Togo. The objective is to assess the acceptability and feasibility of PrEP for men who have sex with men (MSM) as part of a comprehensive HIV prevention package in community-based clinics in West Africa. The SRH group is coordinating the Sexually Transmitted Infections diagnostics and quality control, and the qualitative substudy.  ITM is collaborating in this project with partners from France (IRD Montpellier & Marseille, Coalition Plus) and from 4 countries in West Africa (ARCAD-SIDA, Bamako, Mali; AAS, Ouagadougou, Burkina Faso; Espace Confiance, Abidjan, Côte d’Ivoire; Espoir Vie Togo, Lomé, Togo). The project started in 2017, for four years, and a follow-up project is correctly being planned. 

Contact person: Bea Vuylsteke
Website: Access to Pre-exposure Prophylaxis for Men Who Have Sex With Men

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